Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 75 COMMUNITY SUBSTANCE ABUSE SERVICE STANDARDS
Date:
08/31/2009
Document:
DHS 75.10 Medically managed inpatient treatment service.
(1) SERVICE DESCRIPTION. A medically managed inpatient treatment service is operated by a general or specialty hospital, and includes 24-hour nursing care, physician management and the availability of all other resources of the hospital.
(2) REQUIREMENTS. To receive certification from the department under this chapter, a medically managed inpatient treatment service shall comply with all requirements included in s. DHS 75.03 that apply to a medically managed inpatient treatment service, as shown in Table 75.03, and, in addition, a medically managed inpatient treatment service shall comply with the requirements of this section. If a requirement in this section conflicts with an applicable requirement in s. DHS 75.03, the requirement in this section shall be followed.
(3) ORGANIZATIONAL REQUIREMENTS. Before operating or expanding an inpatient treatment service, a facility shall do all of the following:
(a) Submit for approval to the department, a written justification for the service, documenting if the service has been operating, the service's effectiveness and the need for additional inpatient treatment resources in the geographic area in which the service will operate or is operating.
(b) Notify the county department of community programs under s. 51.42, Stats., in the area in which the service will operate or is operating of the intention to begin to operate or expand the service.
(c) Be approved as a hospital under ch. DHS 124.
(4) REQUIRED PERSONNEL. (a) An inpatient treatment service shall have all of the following personnel:
1. A director who is responsible for the overall operation of the service, including the therapeutic design and delivery of services.
2. A medical director.
3. A consulting psychiatrist who is licensed under ch. 448, Stats., and board-certified or eligible for certification by the American board of psychiatry and neurology or a consulting clinical psychologist licensed under ch. 455, Stats., who will be available as needed, with a written agreement to that effect. Each consultant shall be sufficiently knowledgeable about substance abuse and dependence treatment to carry out his or her assigned duties.
4. A mental health professional who is available either as an employee of the service or through written agreement to provide joint and concurrent services for the treatment of dually diagnosed patients.
5. At least one full-time certified substance abuse counselor for every 10 patients or fraction thereof.
6. At least one clinical supervisor on staff to provide ongoing clinical supervision of the counseling staff, or a person outside the agency who is a clinical supervisor and who by written agreement will provide ongoing clinical supervision of the counseling staff.
(b) A clinical supervisor who meets the requirements of a substance abuse counselor may provide direct counseling services in addition to his or her supervisory responsibilities.
(c) A trained staff member designated to be responsible for the operation of the service shall be on the premises at all times. That person may provide direct counseling or other duties in addition to being in charge of the service.
(d) Other persons, such as volunteers and students, may work in an inpatient treatment facility if all of the following conditions are met:
1. Volunteers and students do not replace direct care staff required under par. (a) or carry out the duties of direct care staff, and there are written descriptions of their responsibilities and duties.
2. Volunteers and students are supervised by professional staff.
3. The inpatient treatment service has written procedures for selecting, orienting and providing in-service training to volunteers.
4. Volunteers and students meet the sensitivity and training expectations under s. DHS 75.03 (3) (h).
(5) CLINICAL SUPERVISION. (a) A medically managed inpatient treatment service shall provide for ongoing clinical supervision of the counseling staff. Ongoing clinical supervision shall be provided as required in s. RL 162.01.
Note: Section RL 162.01 (1) states that a clinical supervisor shall provide a minimum of:
1. Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
2. Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
3. One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
4. One in person meeting each calendar month with a substance abuse counselor-in-training, substance abuse counselor, or clinical substance abuse counselor. This meeting may fulfill a part of the requirements above.
(b) A clinical supervisor shall provide supervision to substance abuse counselors in the areas identified in s. RL 162.01 (5).
Note: Section RL 162.01 (5) states that the goals of clinical supervision are to provide the opportunity to develop competency in the transdisciplinary foundations, practice dimensions and care functions, provide a context for professional growth and development and ensure a continuance of quality patient care.
(6) SERVICE OPERATIONS. (a) A physician, registered nurse or physician assistant shall conduct medical screening of a patient no later than 24 hours after the person's admission to a service to identify health problems and to screen for communicable diseases.
(b) A service shall arrange for services for a patient with medical needs unless otherwise arranged for by the patient.
(c) A service shall complete intake within 24 hours of a person's admission to the service except that the initial assessment and treatment plan shall be completed within 4 days of admission.
(d) A service shall arrange for additional psychological tests for a patient as needed.
(e) A service shall have a written statement describing its treatment philosophy and objectives in providing care and treatment for substance abuse problems.
(f) A substance abuse counselor or other qualified staff member of a service shall provide a minimum of 12 hours of counseling per week for each patient, including individual and group counseling. Family and couples counseling shall be provided or made available, when appropriate. The service shall ensure that:
1. Each patient receives at least one hour of individual counseling per week.
2. The service's treatment schedule is communicated to patients in writing and by any other means necessary for patients with communication difficulties.
(g) Services required by a patient but not provided by a service shall be provided by other appropriate hospital services or outside agencies.
(h) A service staff member shall be trained in life-sustaining techniques and emergency first aid.
(i) A service shall have a written policy on urinalysis that shall include both the following:
1. Procedures for collection and analysis of samples.
2. A description of how urinalysis reports are used in the treatment of a patient.
(7) ADMISSION. (a) Admission to an inpatient treatment service shall be by order of a physician. The physician's referral shall be in writing or indicated by the physician's signature on the placement criteria summary.
(b) Admission to an inpatient treatment service is appropriate only if one of the following conditions is met:
1. The person to be admitted is determined appropriate for placement in this level of care by the application of approved placement criteria.
2. The person to be admitted is determined appropriate for this level of care through the alternative placement recommendations of WI-UPC or other approved placement criteria.
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